The effect of goal-directed ultrasonography to clinical decision making for emergency physician on diagnosis non-traumatic shock patients in emergency department

The aim of this study was to determine effect of ?goal-directed ultrasonography? on real-time clinical decision making of emergency physicians (EPs) evaluating their effect of preliminary diagnosis, additional laboratory and radiological investigations and treatment in patients who present to emergency department (ED) with non-traumatic shock. This prospective single center clinical study was conducted between April 2011 and January 2013 in an urban tertiary care university hospital ED, with an annual census of 90,000 adult patients. Non-traumatic patients over 16 years old presented with a systolic blood pressure less than 100 mmHg and with a shock index (pulse/systolic blood pressure) greater than 1 were evaluated. The effect of clinical decision making as mentioned above were performed by checklist on the study form before and after goal-directed ultrasonography. Primary outcome measures of the study were to determine the effect of goal-directed ultrasonography on real-time clinical decision making of EPs evaluating their effect of preliminary diagnosis, additional laboratory and radiological investigations and treatment in patients presenting with non-traumatic shock to ED. Final statistical analysis was performed on 141 patients. EPs ordered new laboratory tests or radiological investigations for 25 patients (17,7%) and changed their treatment order in 57 patients (40,4%) after performing the goal directed ultrasonography. While it was compared before and after ultrasonography examination, the number of initial diagnosis was decrease on 51 (36,2%) patients. Furthermore the new preliminary diagnosis was occurred on six (4,3%) patients. Definitive diagnosis was consistent with the preliminary diagnosis declared after the goal-directed ultrasonography examination in 87,9% patients. In conclusion, goal-directed ultrasonography performed by EPs in non-traumatic patients with shock, is a diagnostic tool that can be used appropriately in the early diagnostic process along with ordering laboratory tests and starting emergency treatment